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24 h动态心电图联合血清AnxA1、EMP检查诊断无典型症状冠心病心肌缺血的临床研究
郭小慧
李静钰
作者及单位信息
·
DOI： 10.3760/cma.j.cn341190-20240814-01039
Clinical observation of 24-hour dynamic electrocardiogram combined with serum AnxA1 and endothelial microparticle testing in the diagnosis of myocardial ischemia in patients with coronary heart disease without typical symptoms
Guo Xiaohui
Li Jingyu
Authors Info & Affiliations
Guo Xiaohui
Electrocardiogram Room, The Third People's Hospital of Zhengzhou, Zhengzhou 450000, Henan Province, China
Li Jingyu
Electrocardiogram Room, The Third People's Hospital of Zhengzhou, Zhengzhou 450000, Henan Province, China
·
DOI： 10.3760/cma.j.cn341190-20240814-01039
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摘要

目的探究24 h动态心电图联合血清膜联蛋白A1（AnxA1）、血清内皮微粒（EMP）检查用于诊断无典型症状冠心病心肌缺血的临床价值。

方法回顾性分析2021年1月至2024年4月郑州市第三人民医院收治的无典型症状的80例疑似冠心病心肌缺血患者的临床资料，根据冠脉造影检查（CAG）结果对患者进行分组，CAG检查结果为阳性的患者作为研究组，共49例；CAG检查结果为阴性的患者作为对照组，共31例。比较两组患者的一般临床资料、血清AnxA1、EMP水平、心肌缺血发作持续时间和心肌缺血ST段压低发作时间，通过受试者工作特征（ROC）曲线分析各指标用于诊断无典型症状冠心病心肌缺血的效能、敏感度和特异度。

结果研究组患者血清AnxA1［（3.38±1.02）μg/L］、EMP［（1 415±210）×10 6/Ls］均高于对照组［（0.38±0.11）μg/L和（1 179±119）×10 6/Ls］，且心肌缺血发作持续时间［（275.17±53.98）s］也较对照组［（240.69±44.58）s］长，差异均有统计学意义（ t=16.28、5.70、2.97，均 P < 0.05）；通过ROC曲线分析24 h动态心电图、血清AnxA1、EMP水平检测及三种方式联合检测用于无典型症状冠心病心肌缺血诊断的临床价值，发现联合检测的诊断效能最高，曲线下面积为0.961，敏感度为0.980，特异度为0.677。

结论24 h动态心电图、血清AnxA1、EMP检查用于无典型症状冠心病心肌缺血的诊断均具有一定的临床价值，且联合检测诊断的效果更好。

冠心病;心肌梗死;计算机体层摄影血管造影术;膜联蛋白A1;心电描记术，便携式
ABSTRACT

ObjectiveTo investigate the clinical value of 24-hour dynamic electrocardiogram combined with serum Annexin A1 (AnxA1) and endothelial microparticle (EMP) testing in the diagnosis of myocardial ischemia in patients with coronary heart disease without typical symptoms.

MethodsA retrospective analysis was conducted on the clinical data of 80 patients with suspected coronary heart disease with myocardial ischemia and atypical symptoms who were admitted to The Third People's Hospital of Zhengzhou from January 2021 to April 2024. Based on the results of coronary angiography (CAG), patients were divided into groups: those with positive CAG results were assigned to the study group ( n = 49), while those with negative CAG results were assigned to the control group ( n = 31). The general clinical data, serum AnxA1 and EMP levels, duration of myocardial ischemia episodes, and the timing of ST-segment depression during myocardial ischemia were compared between the two groups. The efficacy, sensitivity, and specificity of each indicator for diagnosing myocardial ischemia in coronary heart disease without typical symptoms were analyzed using receiver operating characteristic curves.

ResultsIn the study group, serum AnxA1 and EMP levels were (3.38 ± 1.02) μg/L and (1 415 ± 210) × 10 6/Ls, respectively, which were significantly higher than those in the control group, where the levels were (0.38 ± 0.11) μg/L and (1 179 ± 119) × 10 6/Ls ( t = 16.28, 5.70, both P < 0.05). Additionally, the duration of myocardial ischemia episodes in the study group was (275.17 ± 53.98) seconds, significantly longer than the (240.69 ± 44.58) seconds observed in the control group ( t = 2.97, P < 0.05). Receiver operating characteristic curve analysis results demonstrated the clinical value of the 24-hour dynamic electrocardiogram, serum AnxA1 and EMP levels, individually and in combination, for diagnosing myocardial ischemia in coronary heart disease without typical symptoms. Notably, the combined application showed the highest diagnostic efficacy, with an area under the curve of 0.961, a sensitivity of 0.980, and a specificity of 0.677.

ConclusionsThe use of 24-hour dynamic electrocardiogram and serum AnxA1 and EMP testing for the diagnosis of myocardial ischemia in coronary heart disease without typical symptoms all have certain clinical value, and the combined application shows even greater diagnostic effectiveness than a single application.

Coronary disease;Myocardial infarction;Computed tomography angiography;annexin A1;Electrocardiography，ambulatory
Guo Xiaohui, Email: mocdef.3ab614512451_bbb
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引用本文

郭小慧,李静钰. 24 h动态心电图联合血清AnxA1、EMP检查诊断无典型症状冠心病心肌缺血的临床研究[J]. 中国基层医药,2025,32(03)：404-408.

DOI:10.3760/cma.j.cn341190-20240814-01039

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冠心病（CAD）是一种常见的心血管疾病，其发病率和病死率在全球范围内居高不下，有统计显示，每年约有900万人因此丧生，是导致全世界人口死亡的主要原因之一 ［ 1 , 2 , 3 ］ 。CAD的典型症状包括胸痛、胸闷、呼吸困难等 ［ 4 ］ 。临床上还存在一类无典型症状的CAD患者 ［ 5 ］ ，这些患者可能由于症状不明显或不典型而未能及时得到诊断和治疗，从而增加了严重心血管事件的风险。因此，探索一种有效的无典型症状CAD的诊断方法显得尤为重要。24 h动态心电图（Holter）作为一种非侵入性、持续监测心脏电活动的方法，在CAD的早期诊断中展现了潜在价值。Holter可以记录患者在日常活动中的心电图变化，捕捉到短暂的心肌缺血事件，为无典型症状CAD的筛查提供了可能 ［ 6 ］ 。此外，一些生物标志物在心血管疾病的诊断和预后评估中发挥着重要作用。膜联蛋白A1（AnxA1）是一种抗炎蛋白质，研究表明其在心肌缺血再灌注损伤中的表达显著上调，具有保护心肌细胞的作用 ［ 7 ］ 。血清内皮微粒（EMP）作为内皮细胞损伤的标志物，其水平升高与动脉粥样硬化型心血管疾病的严重程度相关 ［ 8 ］ 。本研究旨在探讨24 h动态心电图检查结合血清AnxA1、EMP检测在无典型症状CAD心肌缺血诊断中的临床价值。现报告如下。
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备注信息
A
郭小慧，Email： mocdef.3ab614512451_bbb
B

郭小慧：酝酿和设计实验、实施研究、采集数据、分析数据；李静钰：撰写文章、文章审阅

C
郭小慧, 李静钰. 24 h动态心电图联合血清AnxA1、EMP检查诊断无典型症状冠心病心肌缺血的临床研究[J]. 中国基层医药,2025,32(3):404-408. DOI:10.3760/cma.j.cn341190-20240814-01039.
D
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